Guidelines Aim To Clear Confusion Over Ear Tubes For Kids

Doctors have been putting in a lot of ear tubes. It's the most common outpatient surgery in children.

Despite how common the tubes are, it's been hard for parents to know if and when a child should get them. "Pediatricians are confused about it too," says Dr. Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y. "And ENT doctors."

To reduce the confusion, the American Academy of Otolaryngology-Head and Neck Surgery has issued the first guidelines on ear tubes, officially known as tympanostomy tubes.

The tiny tubes are placed in the eardrum to drain fluid from the middle ear. The idea is to reduce the risk of repeat ear infections and hearing loss. About 7 percent of children have tubes by age 3. It's a $3 billion-a-year business, Rosenfeld says, and not all of those kids benefit.

Children often get fluid in their ears after ear infections, but the fluid usually goes away on its own, even if it's been there for several months.

The new guidelines say that tubes should not be considered in children who have had fluid in the ears for less than three months.

Children with repeated ear infections also don't always need tubes, the guidelines say. "That's different than what's being done in a lot of practices," Rosenfeld, who chaired the guideline committee, tells Shots. In many cases the infections clear up on their own.

Candidates for tubes include children with frequent ear infections and fluid that never really clears up, as well as kids with fluid and other symptoms such as hearing loss, balance problems and poor school performance.

Children with symptoms of autism may also need tubes, the guidelines say, because the short-term hearing issues that comes with fluid in the ear can compound their issues.

The big news for children who already have tubes is that they almost certainly don't need ear plugs or neoprene headbands to swim. This apparatus is often prescribed to keep water out of the tubes.

"You don't need to worry," Rosenfeld says. The tubes are so small that a child would have to swim more than 6 feet deep to push water through the hole into the ear, he says. "They can swim, bathe, jump in the pool, go to the beach. You don't need to keep water out of the ears."

So then why are ear doctors recommending this stuff? The big clinical trial showing that ear plugs don't reduce ear infections was done in 2005.

"The evidence on this is not new," Rosenfeld agrees. "It just hasn't been disseminated and implemented in practice."

If the message catches hold this time, it may get even more crowded at the pool!